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MS. JENNIFER I KOOP OLSTA PHD

Clinical Neuropsychologist

Milwaukee, Wisconsin

Provider NPI: 1053362897

Provider Information:
MS. JENNIFER I KOOP OLSTA PHD
Gender: F
Not Sole Proprietor

Practice Location:
9200 W WISCONSIN AVE FROEDTERT & MED COLLEGE CLIN - WEST MILWAUKEE, WI 53226 US
Tel: 414-805-5660  Fax: 414-259-9012

Business Mailing Address:
9200 W WISCONSIN AVE FROEDTERT & MED COLLEGE CLIN - WEST MILWAUKEE, WI 53226 US
Tel: 414-805-5660  Fax: 414-259-9012

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
WI2558

Other Provider Identifiers:

IssuerNumberStateType
39149800WI05
1053362897WI05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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